Spinal InfectionsTreatment (3)

• Indications for surgical Rx

– Unable to obtain diagnosis by closed means

– Significant abscess formation

– Failed medical Rx (antibiotics / immobilisation)

including intolerance

– Bone destruction with deformity / instability

– Progressive neurological deficit

Spinal InfectionsTreatment (4)

• Principles of surgical Rx

– excise necrotic tissue back to healthy margins

– decompress spinal canal where necessary

– tissue samples for microbiology / histology

– reconstruction / stabilisation of defect

approach and technique dictated by spinal level and

region to be debrided

Spinal InfectionsOutcome (1)

• Successful non-op Rx predicted by

– age < 60 years

– immune competence

– S aureus infection

ESR (or other inflammatory index)

(in absence of indication for surgical Rx)

Spinal InfectionsOutcome (2)

• Surgical Rx outcome

– less chronic back pain overall (cf non-op)

– related to pre-op neurological status

(quad < paraplegic < paraparesis)

– epidural abscess < granulation tissue

TB Spine

Predisposing factors

• HIV and Acquired Immuno-deficiency Syndrome

• Socially deprived

• Ageing population

• Intra-venous drug abuse

• Previous infections or malignancy

Clinical Presentation

• Constitutional• Local• Deformity

-Knuckle (collapse of one vertebra)

-Gibbus deformity (more than one vertebra)• Cold abscess (retropharyngeal/chest/psoas abscess)• Paraplegia

-Early onset

Late-onset

Investigations

• WBC • ESR• CRP• Chest x-ray• Mantoux or Heaf skin test• Enzyme-linked immunosorbent assay (ELISA) • Polymerase chain reaction (PCR)• Plain radiographs• CT scan • MRI scan• CT guided biopsy (histological or microbiological confirmation)

D/D

1-Brucellosis

2-Malignancy

3-Pyogenic osteomyelitis,

Management

Medical treatment

• Rest/Plaster jacket/Multi-drug anti-tuberculous chemotherapy

Surgical Treatment• Decompression, correction of deformity & anterior

spinal fusion

Thoracic TB - MRI

Thoracic Tuberculosis - Postoperative Appearances